GenIC Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)

Instruction: This form should be completed by the primary contact person from the Program sponsoring the collection.

DETERMINE IF YOUR COLLECTION IS APPROPRIATE FOR THIS GENERIC CLEARANCE MECHANISM:

Instruction: Before completing and submitting this form, determine first if the proposed collection is consistent with the scope of the Collection of Routine Customer Feedback generic clearance mechanism. To determine the appropriateness of using the Collection of Routine Customer Feedback generic clearance mechanism, complete the checklist below.

If you select “yes” to all criteria in Column A, the Collection of Routine Customer Feedback generic clearance mechanism can be used. If you select “yes” to any criterion in Column B, the Collection of Routine Customer Feedback generic clearance mechanism cannot be used.

Column A	Column B
The information gathered will only be used internally to CDC. [X ] Yes [ ] No	Information gathered will be publicly released or published. [ ] Yes [X ] No
Data is qualitative in nature and not generalizable to people from whom data was not collected. [ X] Yes [ ] No	Employs quantitative study design (e.g. those that rely on probability design or experimental methods) [ ] Yes [X ] No
There are no sensitive questions within this collection (e.g. sexual orientation, gender identity). [X ] Yes [ ] No	Sensitive questions will be asked (e.g. sexual orientation, gender identity). [ ] Yes [X ] No
Collection does not raise issues of concern to any other Federal agencies. [ ] Yes [X ] No	Other Federal agencies may have equities or concerns regarding this collection. [ ] Yes [X ] No
Data collection is focused on determining ways to improve delivery of services to customers of a current CDC program. [X ] Yes [ ] No	Data will be used to inform programmatic or budgetary decisions, for the purpose of program evaluation, for surveillance, for program needs assessment, or for research. [ ] Yes [ X ] No
The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future. [X ] Yes [ ] No

Did you select “Yes” to all criteria in Column A?

If yes, the Collection of Routine Customer Feedback generic clearance mechanism may be appropriate for your investigation. You may proceed with this form.

Did you select “Yes” to any criterion in Column B?

If yes, the Collection of Routine Customer Feedback generic clearance mechanism is NOT appropriate for your investigation. Stop completing this form now.

TITLE OF INFORMATION COLLECTION: Dating Matters Customer Satisfaction Survey

PURPOSE: The Centers for Disease Control and Prevention (CDC) created the Dating Matters Toolkit to increase the uptake and national dissemination of a comprehensive teen dating violence prevention model. The Toolkit was released in October 2019 and we have received informal feedback thus far. This proposal seeks to survey customers about the usability and content provided in the Toolkit. The primary target audience for the Toolkit includes CDC grantees, partners in state, local, tribal government agencies, and violence prevention practitioners. The secondary audience includes public health practitioners, and anyone interested in learning more about teen dating violence prevention.

CDC's Division of Violence Prevention (DVP) will use a two-pronged approach to implement:

1) an online customer satisfaction survey with recipients and partners who may use the Dating Matters Toolkit, and

2) a remote access interview to explore if Dating Matters Toolkit webpages (navigation and content) provide users with a satisfactory experience and meet the needs of CDC's services in the violence prevention field.

We will use the information gathered from the customer satisfaction surveys and interviews to update and improve the web content and navigation in the next fiscal year.

At the end of the general questions in the online survey, users will have an opportunity to voluntarily opt-in to the interviews by providing their email address to a contractor. Once users opt in, they will be assigned to one of five interview versions that correspond to specific sections of the web content and/or specific materials on the website (see below for list) to allow each component to be reviewed in more depth by a small number of respondents (N= 17 total interviews):

• Youth Program Facilitator and Youth Program component page (N= 3 participants)

• Parent Program Facilitator and Parent Program component page (N= 3 participants)

• Prevention Lead and Guide to Using Indicator Data (N= 2 participants)

• Prevention Lead and Guide to Informing Policy (N= 2 participants)

• Prevention Lead and Guide to Implementation (N= 2 participants)

• I2i Program Facilitator and i2i Youth Communications Program (N= 2 participants)

• Coach and Coaches Playbook (N= 2 participants)

• Coach, Training for Educators, and Capacity Assessment and Planning Tool (N= 1 participant)

Although many of the questions in the interview versions are similar or overlapping, some are unique to the specific content being reviewed. Participants will be asked via email to review specific web content in advance of their interview.

Information collected from the customer satisfaction surveys will be used to improve the web content and usability, and develop future resources. The data will also inform dissemination and communication, and it will help CDC assess if the agency is providing appropriate information to the intended audience, while using the most innovative and engaging user design. Information gathered will be used only internally for general service improvement and is not intended for release outside of the agency. Information gathered will not be used for the purpose of substantially informing influential policy decisions. Without these types of feedback, the Agency will not have timely information to adjust its services to meet customer needs.

DESCRIPTION OF RESPONDENTS:

Participation in the customer satisfaction surveys and interviews is voluntary. Users will provide feedback to CDC through Survey Monkey for the survey portion, and remote participation interviews will be conducted via Zoom. Participants for the customer satisfaction survey will be selected from two lists: DVP recipients and partners, and VetoViolence users. The lists include local and state health departments, non-profit organizations, foundations, and educational institutions with a focus on violence prevention.

TYPE OF COLLECTION: (Check one)

Instruction: Please sparingly use the Other category

[ ] Customer Comment Card/Complaint Form [X ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ X] Other: _Interviews_____________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

Name:_______________Karen Angel_________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ X] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X ] No

This submission has been reviewed by the CDC NCIPC’s Information Systems Security Officer, who has determined that the Privacy Act does not apply because CDC will not have access to or receive any personally identifiable information (PII) about participants. (Att. 4).

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X ] No

If Yes: Please describe the incentive. If amounts are outside of customary incentives, please also provide a justification.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Recruitment letter	500	3/60	25
DVP grantees, DVP partners, and Veto Violence account holders -Online Survey	50	30/60	25
DVP grantees, DVP partners- Remote Interview	17	60/60	17
Totals			67

FEDERAL COST: The estimated annual cost to the Federal government is __$7,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ X] Yes [ ] No

If Yes: Please provide a description of both below (or attach the sampling plan)

If No: Please provide a description of how you plan to identify your potential group of respondents and how you will select them or ask them to self-select/volunteer

This usability testing effort will draw from two groups of potential respondents. The first group includes DVP recipients, DVP partners, and VetoViolence users. The second group includes DVP partners and recipients who may be more familiar with program implementation. DVP staff will be responsible for identifying and inviting grantees and partners to participate in the usability testing effort (Att.2). The contractor will invite participants to test the Dating Matters website and communicate with potential respondents about the interviews (Att.3).

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ X ] Other, Explain - Remote access interview

2. Will interviewers or facilitators be used? [ X ] Yes [ ] No

DVP Project Officers or appropriate DVP staff person with a working relationship with the partner will send recruitment letters to grantees and partners inviting them to participate in the testing effort (Att. 1). The respondents will be asked to review the Dating Matters Toolkit webpages. After reviewing the webpages, the respondent will be asked to respond to survey questions related to the task he or she has just reviewed (Att. 2 and 2a).

At the end of the survey, respondents will be asked if they would voluntarily participate in an interview to provide feedback on a specific role or component(Att 3). The contractor will reach out to the respondents to schedule the individual interviews. Based on the individual’s experience and role in their organization, they will be assigned one role and its component based on the list above.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

6